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[Idiopathic peri-cerebral enlargement in infants: simple anatomical variant or hemorrhagic risk factor?]
A Gout1, I Gautier, M Bellaiche
1Service de pédiatrie, centre hospitalier de Versailles, Le Chesnay, France.
Insights
Idiopathic subarachnoid space enlargement (ISSE) may not always be benign. This condition can contribute to subdural hematoma development, even without a history of head trauma in infants.
Area of Science:
- Pediatric Neurology
- Neuroradiology
Background:
- Idiopathic subarachnoid space enlargement (ISSE) is typically considered a benign finding in infants.
- The clinical significance of ISSE, particularly in relation to acute neurological events, requires further investigation.
Observation:
- Two infants presented with neurological disorders, including subdural hematoma, in association with ISSE.
- Neither infant had a history of head injury; accelerated cranial perimeter growth was noted retrospectively in both cases prior to the acute event.
- One infant experienced a subdural hematoma after a life-threatening event, while the other developed empyema complicating a subdural hematoma with ISSE.
Findings:
- The cases suggest ISSE can be a contributing factor in the development of subdural hematoma in infants.
- The absence of trauma history in these cases highlights a potential non-traumatic etiology for subdural hematoma associated with ISSE.
- Radiological findings (CT and MRI) were crucial in diagnosing subdural hematoma and associated complications like empyema in the context of ISSE.
Implications:
- ISSE should be recognized as a potential risk factor for subdural hematoma, necessitating careful evaluation even in the absence of reported head trauma.
- This challenges the traditional view of ISSE as exclusively benign and suggests a need for increased vigilance in pediatric neurological assessments.
- Further research is warranted to elucidate the precise mechanisms by which ISSE may predispose infants to subdural hematoma.
Background:
Idiopathic subarachnoid space enlargement (ISSE) is usually regarded as a benign lesion.
Case Reports:
Two infants, 6 and 8 months old respectively, were hospitalized for neurological disorders revealing subdural hematoma. The first one was drowsy after an apparent life threatening event. The CT scan showed a recent subdural hematoma with ISSE. The outcome was spontaneously uneventful. The second patient presented a febrile hemiconvulsion preceding a status epilepticus. The diagnosis of empyema complicating subdural hematoma with ISSE was done on MRI. Recovery occurred after a 3 week course of parenteral antibiotics and 1 year of antiepileptic treatment. In these two cases, there was no history of head injury and the retrospective study of cranial perimeter growth curves showed acceleration before the acute event.
Conclusion:
The reputation of benignity is not usurped regarding the ISSE. Nevertheless, it must be recognized as a factor furthering emergence of subdural hematoma, even in absence of injury context.